VA102238 (1290)    PLAN (366.03)

Name Value
ID VA102238
NAME INDIANA MEDICAID FULL ADJUDICATION
NAME - SHORT INMEDFA
REGION IN
DATE/TIME CREATED 2004-02-13 21:48:57
PHARMACY BENEFITS MANAGER NAME NONE
BANKING IDENTIFICATION NUMBER 610084
PROCESSOR CONTROL NUMBER (PCN) DRRXPROD
NCPDP PROCESSOR NAME ACS
ENABLED? Yes
BILLING PAYER SHEET NAME ACSINMB1
REVERSAL PAYER SHEET NAME ACSINB2
REBILL PAYER SHEET NAME ACSINMB1
MAXIMUM NCPDP TRANSACTIONS 4
APPLICATION
  • E-PHARM
    NATIONAL ACTIVE?:   Active
    LOCAL ACTIVE?:   Not Active
    USER EDITED LOCAL:   INTERFACE,IB EIV
    DATE/TIME LOCAL EDITED:   2006-05-25 15:17:30
    DATE/TIME NATIONAL EDITED:   2004-02-15 12:44:51
    DEACTIVATED?:   No
    DATE/TIME CREATED:   2004-02-15 12:44:51